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Spinal Cord Stimulation: Comparing Traditional Low-frequency Tonic Waveforms to Novel High Frequency and Burst Stimulation for the Treatment of Chronic Low Back Pain

  • Other Pain (A. Kaye and N. Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of the present investigation is to summarize supporting evidence for novel sub-perception spinal cord stimulation (SCS) therapy over traditional paresthesia inducing low-frequency waveforms for the treatment of chronic pain. The focus of this review is to summarize key studies comparing traditional low-frequency tonic waveforms to modern high frequency and burst stimulation for the treatment of patients with chronic intractable low back pain and/or leg pain.

Recent Findings

Several recent studies have demonstrated the benefit of novel SCS therapies over traditional low-frequency SCS for the treatment of patients with chronic low back and/or leg pain. SENZA-RTC showed that paresthesia-free high-frequency SCS was superior to low-frequency stimulation for treatment of chronic low back pain with leg pain. The SUNBURST crossover trial recently found that high-frequency burst stimulation was preferred over low-frequency tonic SCS with patients citing better pain relief and a preference for paresthesia-free SCS. The new ongoing EVOLVE workflow retrospective multicenter study uses technology that can deliver both low-dose and high-dose SCS. Further, the wavewriter technology addresses patient variability with its ability to layer sub-perception waveforms and paresthesia inducing low-frequency stimulation tailored to patient needs via an interactive feedback feature.

Summary

Neuromodulation for the treatment of chronic pain is rapidly evolving with technology at its forefront. Modern SCS systems use novel waveforms, frequencies, and stimulation modes to deliver paresthesia-free pain relief to patients suffering from chronic low back pain and/or leg pain with better results than traditional tonic low-frequency SCS. As the field advances, new studies are needed comparing new waveform and delivery systems to optimize patient selection and treatment response.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 2010;11:1230–9.

    Article  Google Scholar 

  2. Kennedy J, Roll JM, Schraudner T, Murphy S, McPherson S. Prevalence of persistent pain in the U.S. adult population: new data from the 2010 national health interview survey. J Pain. 2014;15(10):979–84.

    Article  Google Scholar 

  3. Turk DC, Audette J, Levy RM, Mackey SC, Stanos S. Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain. Mayo Clin Proc. 2010;85(3 suppl):S42–50.

    Article  Google Scholar 

  4. Committee on Advancing Pain Research, Care, and Education Board on Health Sciences Policy. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011. p. 28. 113, 129–130, 312

    Google Scholar 

  5. Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146:116–2.

    Article  Google Scholar 

  6. Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943–5.

    Article  CAS  Google Scholar 

  7. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46:489–91.

    CAS  PubMed  Google Scholar 

  8. Kumar K, Nath R, Wyant GM. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. J Neurosurg. 1991;75:402–7.

    Article  CAS  Google Scholar 

  9. North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery. 1993;32:384–94 discussion 394–95.

    Article  CAS  Google Scholar 

  10. Oakley JC. Spinal cord stimulation in axial low back pain: solving the dilemma. Pain Med. 2006;7:C58–C63.

  11. Al-Kaisy A, Van Buyten JP, Smet I, Palmisani S, Pang D, Smith T. Sustained effectiveness of 10kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med. 2014;15:347–54.

    Article  Google Scholar 

  12. Van Buyten JP, Al-Kaisy A, Smet I, Palmisani S, Smith T. High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation. 2013;16:59–65 discussion 65–6.

    Article  Google Scholar 

  13. •• Kapural L, et al. Novel 10-kHz High-frequency therapy (HF10 Therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain- The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015;123:851–60 FDA approval for HF10 neuromodulation and superiority compared to traditional SCS.

    Article  Google Scholar 

  14. •• Kapural L, et al. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial. Neurosurgery. 2016;79.5:667–77 PMC. Web. 23 May 2018. Sustained results in superiority measures for HF10 neuromodulation over traditional SCS.

    Article  Google Scholar 

  15. Sherman SM. Tonic and burst firing: dual modes of thalamocortical relay. Trends Neurosci. 2001;24:122–6.

    Article  CAS  Google Scholar 

  16. Courtney P, Espinet A, Mitchell B, Russo M, Muir A, Verrills P, et al. Improved pain relief with burst spinal cord stimulation for two weeks in patients using tonic stimulation: results from a small clinical study. Neuromodulation. 2015;18:361–6.

    Article  Google Scholar 

  17. De Ridder D, Lenders MW, De Vos CC, et al. A 2-center comparative study on tonic versus burst spinal cord stimulation: amount of responders and amount of pain suppression. Clin J Pain. 2015;31:433–7.

    Article  Google Scholar 

  18. de Vos CC, Bom MJ, Vanneste S, Lenders MW, de Ridder D. Burst spinal cord stimulation evaluated in patients with failed back surgery syndrome and painful diabetic neuropathy. Neuromodulation. 2014;17:152–9.

    Article  Google Scholar 

  19. Schu S, Slotty PJ, Bara G, von Knop M, Edgar D, Vesper J. A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation. 2014;17:443–50.

    Article  Google Scholar 

  20. De Ridder D, et al. Burst spinal cord stimulation for limb and back pain. World Neurosurg. 2013;80:642–649 e1.

    Article  Google Scholar 

  21. •• Deer T, et al. Success Using Neuromodulation With BURST (SUNBURST) Study: Results From a Prospective, Randomized Controlled Trial Using a Novel Burst Waveform. Neuromodulation. 2018;21:56–66 FDA approval for BURST neuromodulation and superiority over traditional SCS.

    Article  Google Scholar 

  22. Sullivan MJLBS, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.

    Article  Google Scholar 

  23. Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976). 2000;25:2940–52 discussion 52.

    Article  CAS  Google Scholar 

  24. Monhemius R, Simpson BA. Efficacy of spinal cord stimulation for neuropathic pain: assessment by abstinence. Eur J Pain. 2003;7:513–9.

    Article  Google Scholar 

  25. Cui JG, Meyerson BA, Linderoth B. Opposite effects of spinal cord stimulation in different phases of carrageenan-induced hyperalgesia. Eur J Pain. 1999;3:365–74.

    Article  CAS  Google Scholar 

  26. Nashold BS Jr, Friedman H. Dorsal column stimulation for control of pain. Preliminary report on 30 patients. J Neurosurg. 1972;36:590–7.

    Article  Google Scholar 

  27. Fleiss JL. Analysis of data from multiclinic trials. Control Clin Trials. 1986;7(4):267–75.

  28. Moore RA, Straube S, Eccleston C, Derry S, Aldington D, Wiffen P, et al. Estimate at your peril: imputation methods for patient withdrawal can bias efficacy outcomes in chronic pain trials using responder analyses. Pain. 2012;153(2):265–68.

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Ariel Morales, R. Jason Yong & Richard D. Urman

  2. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Alan D. Kaye

Authors
  1. Ariel Morales
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  2. R. Jason Yong
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  3. Alan D. Kaye
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  4. Richard D. Urman
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Correspondence to Richard D. Urman.

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Conflict of Interest

Ariel Morales declares no conflict of interest. R. Jason Yong, MD MBA serves as a consultant for Nevro and Medtronic. Alan D. Kaye, MD PhD serves on the Speakers Bureau of Depomed and Merck. Richard D. Urman MD MBA received research funding from Medtronic, Merck, Mallinckrodt and an honorarium from 3M and Sandoz.

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Morales, A., Yong, R.J., Kaye, A.D. et al. Spinal Cord Stimulation: Comparing Traditional Low-frequency Tonic Waveforms to Novel High Frequency and Burst Stimulation for the Treatment of Chronic Low Back Pain. Curr Pain Headache Rep 23, 25 (2019). https://doi.org/10.1007/s11916-019-0763-3

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  • DOI: https://doi.org/10.1007/s11916-019-0763-3

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